急性腔隙性脑梗死认知功能障碍与病变的相关性

Correlation between cognitive impairment and Lesion characteristics of patients with acute first ever lacunar infarction

目的探讨首发急性腔隙性脑梗死(LI)患者认知功能损害与病灶部位及体积的关系。方法急性期初发LI组(70例)和正常对照组(30例)。LI组结合头颅灌注加权成像(DWI)及磁共振血管造影(MRA),分为额叶组(10例)、颞叶组(12例)、基底节组(14例)、丘脑组(16例)和侧脑室旁组(18例),采用简易智力状态检查量表(MMSE)评分、Alzheimer病评定量表-认知亚量表(ADAS-cog)心理测试,评价各亚组与对照组的认知功能。LI组根据MMSE评分,分为血管性认知功能障碍(VCI)组31例和非VCI组39例,采用头颅DWI及MRA,比较各亚组与对照组的病灶体积。结果(1)额叶组、颞叶组、基底节组、丘脑组和侧脑室旁组与正常对照组在记忆力、语言、执行力因子评分差异有统计学意义(P<0.05),而定向力差异无统计学意义(P>0.05);颞叶组、丘脑组与其他三组之间在记忆力评分具差异有统计学意义(P<0.05);丘脑组与其余四组在语言能力差异有统计学意义(P<0.05);额叶、颞叶与其余三组在执行力因子评分差异有统计学意义(P<0.05);(2)急性期病灶体积VCI组与非VCI组比较差异无统计学意义(P>0.05)。结论病灶部位是LI患者出现认知功能受损的重要因素,病灶体积与LI患者认知功能无明显关系。

Objective To investigate the relationship between the cognitive impairment and lesion characteristics of patients with acute first ever lacunar infarction. Methods In this prospective cohort study, according to DWI and MRA, LI group were divided into frontal lobe group （ 10 eases）, temporal lobe group （ 12 cases）, basal ganglia group （ 14 cases）, thalamus （ 16 cases） and periventricular location group （ 18 cases）. Cognitive function was assessed with MMSE and ADAS-cog in 70 patients with acute first ever lacunar infarction and 30 normal control. According to MMSE score, LI group were divided into VCI group （31 cases） and non-VCI group （39 cases）, the lesion volume were identified on the DWI and MRA. Results （ 1 ） Except for orientation （P 〉 0. 05）, analysis showed that each score of ADAS-cog decreased significantly in patients with various lacunar lesions compared with control subjects （ P 〈 0. 05 ）. The factor score of memory was decreased obviously in patients with lesions in the temporal lobe and thalamus group. There were significant difference in speech score between thalamus group and other four groups. The factor score of executive function was decreased significantly in patients with lesions in the temporal lobe and frontal lobe group. （ 2 ） There was no significant difference in volume of lacunar lesions between VCI group and non-VCI group. Conclusions The lesion location is the important factor in cognitive impairment, but there is no significant difference between cognitive dysfunction and volume of lacunar lesions.